Libido and Erections: Birds of a Feather

Posted on by Paul Turek, MD

I take care of lots of men with erection dysfunction. I also take care of lots of men with low sex drive. And, as you can imagine, I see a lot of men with both issues. And this is where men’s health gets really interesting.

Inside My Mind

I think of erections and libido as separate but related, like distant cousins who live near each other. They may be seen together and kinda look alike, but they take their own paths in life. Although both are governed by the same “rest and restore” nervous system, one can get an erection without having any libido (it happens several times a night to healthy men during their deepest sleep), and one can have a sex drive without an accompanying erection. But admittedly, things are sweetest when these two work together.
In men who note both decreased sex drive and erection issues, which comes first? Does the low sex drive lead to erection issues, or vice versa? Which is the chicken and which is the egg? One of life’s eternal questions that I seek to solve every day.
I take a “planetary” view when it comes to evaluating men’s sexual health. Most of Western medicine looks at testosterone levels when evaluating erection or libido issues. But I rarely find these to be informative. Poke around health issues like heart disease, cholesterol balance, diabetes, obesity and blood pressure and you’ll find a lot more. If those come up short, tackle medications, social drugs, sleep and stress if you fashion yourself a Sherlock Holmes. After all, sexual health is a reflection of overall health.

Inside His Mind

When evaluating low libido, think of it like sexual “breathing.” Men may differ from each other, but each will have a typical pattern. And you can measure it not only by how often they’re having sex, but also by including how often they masturbate, or even think about having sex or masturbating. What is the popular lore: awake 18 year olds think about sex every 3 minutes? Remember here that’s it really the thought that counts.
When examining erection issues, there are simple questions that provide real clues as to the severity of the problem.

  • Is it possible to get normal erections in any situation? (e.g. alone, with a partner). Because if it is, then you know the mechanicals are in good shape.
  • Are there ever instances of morning wood? This doesn’t have to be a full-on erection, as even a short rise counts. Also a good sign that erections are normal.

If, with all of this due diligence, it is still not possible to figure out which of these is the lead problem, I take the Indiana Jones approach when faced with an opponent with a huge Damascus sword against your fists, I try a simple experiment: Fix the erection and watch what happens to libido. My go to drugs for this are the fabulous erectogenic agents Viagra, Levitra, Cialis and Stendra. A great example of better living (and problem solving) through chemistry. So, through targeted history taking, often no small feat, even the knottiest of sexual health problems can be detangled.